Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
Epidemiol Psychiatr Sci. 2022 Jun 15;31:e43. doi: 10.1017/S2045796022000270.
The coronavirus disease 2019 (COVID-19) pandemic and ensuing restrictions have negatively affected the mental health and well-being of the general population, and there is increasing evidence suggesting that lockdowns have led to a disruption of health services. In March 2020, South Africa introduced a lockdown in response to the COVID-19 pandemic, entailing the suspension of all non-essential activities and a complete ban of tobacco and alcohol sales. We studied the effect of the lockdown on mental health care utilisation rates in private-sector care in South Africa.
We conducted an interrupted time-series analysis using insurance claims from 1 January 2017 to 1 June 2020 of beneficiaries 18 years or older from a large private sector medical insurance scheme. We calculated weekly outpatient consultation and hospital admission rates for organic mental disorders, substance use disorders, serious mental disorders, depression, anxiety, other mental disorders, any mental disorder and alcohol withdrawal syndrome. We calculated adjusted odds ratios (OR) for the effect of the lockdown on weekly outpatient consultation and hospital admission rates and the weekly change in rates during the lockdown until 1 June 2020.
710 367 persons were followed up for a median of 153 weeks. Hospital admission rates (OR 0.38; 95% confidence interval (CI) 0.33-0.44) and outpatient consultation rates (OR 0.74; 95% CI 0.63-0.87) for any mental disorder decreased substantially after the introduction of the lockdown and did not recover to pre-lockdown levels by 1 June 2020. Health care utilisation rates for alcohol withdrawal syndrome doubled after the introduction of the lockdown, but the statistical uncertainty around the estimates was large (OR 2.24; 95% CI 0.69-7.24).
Mental health care utilisation rates for inpatient and outpatient services decreased substantially after the introduction of the lockdown. Hospital admissions and outpatient consultations for alcohol withdrawal syndrome increased after the introduction of the lockdown, but statistical uncertainty precludes strong conclusions about a potential unintended effect of the alcohol sales ban. Governments should integrate strategies for ensuring access and continuity of essential mental health services during lockdowns in pandemic preparedness planning.
2019 年冠状病毒病（COVID-19）大流行及其后续限制措施对普通民众的心理健康和幸福感产生了负面影响，越来越多的证据表明，封锁导致了卫生服务的中断。2020 年 3 月，南非为应对 COVID-19 大流行而实施了封锁，暂停了所有非必要活动，并完全禁止销售烟草和酒精。我们研究了封锁对南非私营部门医疗保健利用率的影响。
我们使用来自一家大型私营部门医疗保险计划的 18 岁及以上受益人从 2017 年 1 月 1 日至 2020 年 6 月 1 日的保险索赔数据进行了一项中断时间序列分析。我们计算了有机精神障碍、物质使用障碍、严重精神障碍、抑郁、焦虑、其他精神障碍、任何精神障碍和酒精戒断综合征的每周门诊咨询和住院治疗率。我们计算了封锁对每周门诊咨询和住院治疗率的影响以及封锁期间每周变化的调整比值比（OR），直至 2020 年 6 月 1 日。
710367 人随访中位数为 153 周。任何精神障碍的住院治疗率（OR0.38；95%置信区间（CI）0.33-0.44）和门诊咨询率（OR0.74；95%CI0.63-0.87）在封锁后大幅下降，到 2020 年 6 月 1 日并未恢复到封锁前水平。封锁后酒精戒断综合征的医疗利用率增加了一倍，但估计的统计不确定性很大（OR2.24；95%CI0.69-7.24）。
封锁后，住院和门诊服务的精神保健利用率大幅下降。封锁后，酒精戒断综合征的住院和门诊就诊增加，但统计不确定性排除了对酒精销售禁令潜在意外影响的有力结论。政府应在大流行防范规划中纳入确保封锁期间基本精神卫生服务的获取和连续性的战略。
